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Early Hum Dev. 2013 Dec;89(12):925-30. doi: 10.1016/j.earlhumdev.2013.09.019. Epub 2013 Oct 18.

Social-emotional delays at 2 years in extremely low gestational age survivors: correlates of impaired orientation/engagement and emotional regulation.

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Department of Pediatrics, Loyola University Medical Center and Loyola University of Chicago Stritch School of Medicine, Maywood, IL, United States.



Premature infants are less socially and emotionally competent at school age than infants born at term.


To evaluate the correlates of social and emotional delays at 2 years of age among prematurely born children.


This is a prospective cohort study.


904 children born at <28 weeks gestation during 2002-2004 and enrolled in the ELGAN study who survived until age 2 years and returned for a developmental assessment.


The Bayley Behavior Rating Scale (BRS), a neurological examination, and the Bayley Scales of Infant Development II (BSID-II).


Fully 31% of children had a non-optimal (14%) or questionable (17%) (NO/Q) BRS score for Emotional Regulation (ER), and 27% had a non-optimal (13%) or questionable (14%) score for Orientation/Engagement (O/E). Children with NO/Q scores on ER and O/E were more likely than others to have MDI and PDI scores <70 and be unable to walk. Antecedents of NO/Q OE scores included multi-fetal pregnancy, while antecedents of NO/Q scores for both ER and O/E included indicators of socioeconomic disadvantage, and male sex.


Over 25% of children born extremely premature exhibit socio-emotional delays during developmental assessment at age 2 years. Antecedents of these delays include sociodemographic characteristics, as well as those common antecedents of other impairments commonly observed among extremely preterm infants.


BRS; BSID-II; Bayley Scales Infant Development-II; Behavior Rating Scale; Behavioral regulation; Brain injury; ELGAN; ER; Emotional Regulation; Extreme prematurity; Extremely Low Gestational Age Newborn; GMFCS; Gross Motor Function Classification System; IVH; MDI; Mental Development Index; NO/Q; Neurodevelopmental disability; O/E; Orientation Engagement; PDI; Psychomotor Development Index; intraventricular hemorrhage; non-optimal or questionable

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